Iowa Central Admissions Application (3 for Free)

* indicates a required field

Personal Information
Enter your name as it appears on your Social Security Card
First Name (legal name):
A value is required.
Middle Name/Initial:
Last Name (surname):
A value is required.
Maiden Name:
Invalid format. Musat be in 123-45-7890 format.
Birth Date (month/day/year):
A value is required.
Female Male
A value is required.
P.O. Box:
A value is required.
A value is required.
Zip Code:
A value is required.
Home Phone:
A value is required.Invalid format. Must be in (123) 456-7890 format.
Cell Phone:
I would like to receive text messages about upcoming events at Iowa Central:
Cell Phone Carrier:
(enter only 1 e-mail address)
A value is required.
Iowa Resident:
Date of Residency:
Are you a US Citizen:
If you answered no:
  Country of Birth:
  Country of Citizenship:
  Type of Visa:
Is English your native language?
Ethnicity: (check all that apply)
Native Hawaiian or other Pacific Islander
Black or African-American
American Indian/Alaskan Native
Other Ethnic Group
Prefer not to Respond

Emergency Contact Information
A value is required.
A value is required.

Admissions Information
What Center do you plan to attend? Please select an item.
Term: Please select an item.
Status Entry:
How long do you plan to attend Iowa Central:
Did either of your natural born or adoptive parents (with whom you were living before your 18th birthday) complete a bachelor's degree?
The above information is requested to determine your eligibility for federally-funded assistance programs and will NOT be used in determining admission.

Program Major Information
Select ONE program that you are planning to major in: Please select an item.

High School Information
Name of High School Last Attended:
A value is required.
A value is required.
Are you currently attending High School:
If not a high school graduate, have you earned the GED:
Date GED Earned:
Where GED Earned:

College Attendance Information

List all colleges and universities including Iowa Central, that you have previously attended. Remember to contact each college and request an official transcript be sent to:

Student Records
Iowa Central Community College
One Triton Circle
Fort Dodge, Iowa, 50501

College Name
City, State, ZIP
From (mo/yr)
To (mo/yr)

Housing Information
Do you wish to receive a residence hall app:

You must check the box to the left in order to submit the form.
By checking this box I certify that the above statements are true and correct to the best of my knowledge. I agree to abide by all approved policies as outlined in the current issue of the college catalog. I agree to report all changes, including name and address, to the Admissions Office.